Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia : a randomised study
© 2022. The Author(s)..
BACKGROUND: Treating pneumonia in old patients remains challenging for clinicians. Moreover, bacterial antimicrobial resistance is a major public health threat.
OBJECTIVE: The PROPAGE study evaluated the interest of a strategy using serial measurements of procalcitonin (PCT) to reduce the duration of antibiotic therapy in old patients with pneumonia.
METHODS: PROPAGE took place from Dec.-2013 to Jun.-2016 in eight French geriatric units. It was a prospective, comparative, randomised, open-label study involving old patients (≥ 80 years) who had initiated antibiotic treatment for pneumonia in the previous 48 h. PCT was monitored in all patients and two decision-making PCT-based algorithms guided antibiotic therapy in patients from the PCT group.
RESULTS: 107 patients were randomised (PCT, n = 50; Control, n = 57). Antibiotic therapy exposure was reduced in the PCT group as compared to the Control group (median duration of antibiotic therapy, 8 vs. 10 days [rank-test, p = 0.001]; antibiotic persistence rates on Days 6 and 8, 54% and 44% vs. 91% and 72%) and no significant difference was found in recovery rate (84% vs. 89.5%; Pearson Chi² test, p = 0.402).
CONCLUSION: Although, the superiority of the strategy was not tested using a composite criterion combining antibiotic therapy duration and recovery rate was not tested due to the small sample size, the present study showed that monitoring associated with PCT-guided algorithm could help shorten antibiotic treatment duration in the very old patients without detrimental effects. Measuring PCT levels between Day 4 and Day 6 could be helpful when making the decision regarding antibiotic discontinuation.
TRIAL REGISTRATION: NCT02173613. This study was first registered on 25/06/2014.
Errataetall: |
ErratumIn: BMC Geriatr. 2023 Mar 30;23(1):189. - PMID 36997865 |
---|---|
Medienart: |
E-Artikel |
Erscheinungsjahr: |
2022 |
---|---|
Erschienen: |
2022 |
Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
---|---|
Enthalten in: |
BMC geriatrics - 22(2022), 1 vom: 14. Dez., Seite 965 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Gavazzi, Gaëtan [VerfasserIn] |
---|
Links: |
---|
Themen: |
Aged |
---|
Anmerkungen: |
Date Completed 16.12.2022 Date Revised 30.03.2023 published: Electronic ClinicalTrials.gov: NCT02173613 ErratumIn: BMC Geriatr. 2023 Mar 30;23(1):189. - PMID 36997865 Citation Status MEDLINE |
---|
doi: |
10.1186/s12877-022-03658-4 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM350297010 |
---|
LEADER | 01000naa a22002652 4500 | ||
---|---|---|---|
001 | NLM350297010 | ||
003 | DE-627 | ||
005 | 20231226044700.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231226s2022 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1186/s12877-022-03658-4 |2 doi | |
028 | 5 | 2 | |a pubmed24n1167.xml |
035 | |a (DE-627)NLM350297010 | ||
035 | |a (NLM)36517740 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Gavazzi, Gaëtan |e verfasserin |4 aut | |
245 | 1 | 0 | |a Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia |b a randomised study |
264 | 1 | |c 2022 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 16.12.2022 | ||
500 | |a Date Revised 30.03.2023 | ||
500 | |a published: Electronic | ||
500 | |a ClinicalTrials.gov: NCT02173613 | ||
500 | |a ErratumIn: BMC Geriatr. 2023 Mar 30;23(1):189. - PMID 36997865 | ||
500 | |a Citation Status MEDLINE | ||
520 | |a © 2022. The Author(s). | ||
520 | |a BACKGROUND: Treating pneumonia in old patients remains challenging for clinicians. Moreover, bacterial antimicrobial resistance is a major public health threat | ||
520 | |a OBJECTIVE: The PROPAGE study evaluated the interest of a strategy using serial measurements of procalcitonin (PCT) to reduce the duration of antibiotic therapy in old patients with pneumonia | ||
520 | |a METHODS: PROPAGE took place from Dec.-2013 to Jun.-2016 in eight French geriatric units. It was a prospective, comparative, randomised, open-label study involving old patients (≥ 80 years) who had initiated antibiotic treatment for pneumonia in the previous 48 h. PCT was monitored in all patients and two decision-making PCT-based algorithms guided antibiotic therapy in patients from the PCT group | ||
520 | |a RESULTS: 107 patients were randomised (PCT, n = 50; Control, n = 57). Antibiotic therapy exposure was reduced in the PCT group as compared to the Control group (median duration of antibiotic therapy, 8 vs. 10 days [rank-test, p = 0.001]; antibiotic persistence rates on Days 6 and 8, 54% and 44% vs. 91% and 72%) and no significant difference was found in recovery rate (84% vs. 89.5%; Pearson Chi² test, p = 0.402) | ||
520 | |a CONCLUSION: Although, the superiority of the strategy was not tested using a composite criterion combining antibiotic therapy duration and recovery rate was not tested due to the small sample size, the present study showed that monitoring associated with PCT-guided algorithm could help shorten antibiotic treatment duration in the very old patients without detrimental effects. Measuring PCT levels between Day 4 and Day 6 could be helpful when making the decision regarding antibiotic discontinuation | ||
520 | |a TRIAL REGISTRATION: NCT02173613. This study was first registered on 25/06/2014 | ||
650 | 4 | |a Randomized Controlled Trial | |
650 | 4 | |a Journal Article | |
650 | 4 | |a Research Support, Non-U.S. Gov't | |
650 | 4 | |a Aged | |
650 | 4 | |a Antibiotic duration | |
650 | 4 | |a Bacterial infection biomarkers | |
650 | 4 | |a Pneumonia | |
650 | 4 | |a Procalcitonin | |
650 | 7 | |a Procalcitonin |2 NLM | |
650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
650 | 7 | |a Biomarkers |2 NLM | |
700 | 1 | |a Drevet, Sabine |e verfasserin |4 aut | |
700 | 1 | |a Debray, Matthieu |e verfasserin |4 aut | |
700 | 1 | |a Bosson, Jean Luc |e verfasserin |4 aut | |
700 | 1 | |a Tidadini, Fatah |e verfasserin |4 aut | |
700 | 1 | |a Paccalin, Marc |e verfasserin |4 aut | |
700 | 1 | |a de Wazieres, Benoit |e verfasserin |4 aut | |
700 | 1 | |a Celarier, Thomas |e verfasserin |4 aut | |
700 | 1 | |a Bonnefoy, Marc |e verfasserin |4 aut | |
700 | 1 | |a Vitrat, Virginie |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t BMC geriatrics |d 2001 |g 22(2022), 1 vom: 14. Dez., Seite 965 |w (DE-627)NLM114301786 |x 1471-2318 |7 nnns |
773 | 1 | 8 | |g volume:22 |g year:2022 |g number:1 |g day:14 |g month:12 |g pages:965 |
856 | 4 | 0 | |u http://dx.doi.org/10.1186/s12877-022-03658-4 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 22 |j 2022 |e 1 |b 14 |c 12 |h 965 |